Principal Copays, Deductibles, and Coinsurance Definitions

Dental insurance generally means reduced cost for basic preventive services. The coverage you pay for works like this: Principal insurance pays the cost, or part of the cost, you and your covered family members receive for basic preventive services. Generally, covered services include routine exams, teeth cleaning, and x-rays, as well as other procedures such as cavities, crowns, and root canals.

With a nationwide network of more than 136,000 dentists, it is likely you will find a Principal in-network dental provider close to home. An in-network provider will cost less than one that is out-of-network.

Knowing the following terms is important for understanding the services you receive from Principal:

1. A deductible is the amount you pay for covered services before your insurance plan begins to pay expenses for you.
2. In-network services mean you pay less out-of-pocket because fees are pre-established with Principal.
3. Out-of-network services have higher charges when you choose providers who have not agreed to contracted rates with Principal. Such services generally cost more, and your insurance plan usually covers a lesser percentage.
4. Coinsurance is any remaining balance you pay if your coverage is a Preferred Provider Organization (PPO) plan. Generally, coinsurance ranges from 20 percent to 80 percent of your total bill.
5. Annual maximum, part of most dental policies, is how much Principal will pay per year, typically $1,000 to $2,000. If you reach the annual maximum amount of coverage, you are responsible for paying 100 percent of any remaining cost.

Many people, though not all, access dental insurance through their workplace. If your employer offers dental insurance as part of an employee benefits program, you can enroll in coverage for yourself, your spouse, and eligible dependents up to 26 years old. Depending on the policy, you will likely make group rate premium payments that are lower cost and deducted from your paycheck.

Most dental offices have staff dedicated to the task of filing your claim with Principal on your behalf, which is the preferred method. If you decide to submit your own dental claim, you will need to send Principal the dentist’s itemized statement and a copy of the front and back of your Principal dental insurance ID card.

What Does Dental Insurance Cover?

Principal dental insurance typically covers the following services:

1. Preventive care, such as twice-yearly exams, cleaning, and x-rays (usually once per year), is covered at 100 percent of cost.
2. Basic procedures like cavities or extractions are covered at 80 percent of the cost.
3. Major procedures, including crowns, bridges, and dentures, are covered at 50 percent of the cost.

You are responsible for paying any deductible and remaining balance, again, depending on your employer’s policy. With Principal, you can see a specialist without a referral. Additionally, four oral health programs—periodontal, cancer treatment oral health, second opinion, and general anesthesia—give you the option to receive extra care or get a second opinion. Dental coverage with Principal includes all four.

Check Your Policy for Specific Information

Dental insurance does not cover all services. For example, cosmetic dental procedures such as teeth bleaching, veneers, implants, and braces may not be covered. Check your policy for specific information.

Related Article: What Are the Advantages of Dental Insurance?